In the European Society of Cardiology (ESC) Congress 2022, Dr. Axel Cosmus Pyndt Diederichsen from the Odense University Hospital, Odense, Denmark, presented his group’s study on the benefits of population-based screening for cardiovascular (CV) diseases in reducing the risk of death.¹

CV diseases are the leading cause of death and the main cause of premature death among men currently.¹ Though screening helps early detection and prevention, the current data disagree on the benefits of health checks and CV screening in reducing the risk of death.¹ Therefore, the DANCAVAS study, a community-based, randomized, controlled trial, was designed to investigate the effects of comprehensive imaging-based CV screening on the risk of death and CV events.¹

All men aged 65-74 years who lived in select municipalities in Denmark were identified and included in the study, with no exclusion criteria.¹ Of those participants, 1/3 were invited to screening, while the remaining were not invited.¹ The screening program included electrocardiogram- (ECG-) gated non-contrast computed tomography (CT) scan to detect coronary artery calcium (CAC), atrial fibrillation (AF), aortic aneurysms (AA) and iliac aneurysms (IA); 4-limb blood pressure measurements to detect peripheral arterial disease (PAD) and hypertension; and blood sample collection to detect diabetes mellitus (DM) and hypercholesterolemia.¹ The study’s primary endpoint was all-cause mortality, while the secondary endpoints included stroke, myocardial infarction (MI), amputation due to vascular disease, aortic dissection (AD), and aortic rupture.¹ A post hoc outcome was defined, after a median follow-up of 5.6 years, as the composite of all-cause mortality, stroke, and MI.¹

The baseline characteristics were consistent across both the invited group and the not invited group, with the same average age of 68.8 years.¹ The percentage of the population on prescriptions, such as antihypertensives and lipid-lowering medications the year before randomization, were also consistent across both groups.¹ The rates of hospital admission due to stroke, ischemic heart disease (IHD), PAD, and AA during the 5 years before randomization were consistent among the 2 populations.¹

The primary outcome occurred in 2,106 patients (12.6%) in the invited group and 3,915 patients (13.1%) in the not invited group (HR=0.95; 95% CI: 0.90-1.00; p=0.062).¹ When stratified by age, the effects of screening on the primary outcome appeared to be greater among the group of age 65-69 years (HR=0.89; 95% CI: 0.83-0.96; p=0.004), compared with the group of age 70-74 years (HR=1.01; 95% CI: 0.94-1.09; p=0.747).¹ The secondary endpoint of stroke occurred in 1,169 patients (7.0%) in the invited group and 2,228 patients (7.5%) in the non-invited group (HR=0.93; 95% CI: 0.86- 0.99; p=0.035).¹ In addition, the secondary endpoint of MI occurred in 431 patients (2.6%) in the invited group and 833 patients (2.8%) in the non-invited group (HR=0.91; 95% CI: 0.81-1.03; p=0.134).¹ Besides, the post hoc defined composite outcome occurred in 3,335 patients (19.9%) in the invited group and 6,308 patients (21.2%) in the not invited group (HR=0.93; 95% CI: 0.89-0.97; p<0.001).¹ The rates of adverse event (AE) were consistent across both groups, with HR close to 1, suggesting a consistent safety profile between screening and not screening.¹

The study calculated that screening, medication and visits to primary physicians and hospitals incurred an additional healthcare cost of €207 per person, while the quality-adjusted life years (QALY) gained per person was 0.023, giving an incremental cost-effectiveness ratio (ICER) of €9,075 per QALY.¹ However, the cost was much lower among the age group of 65-69 years, with €3,860 per QALY.¹

The DANCAVAS study did not demonstrate that CV screening among men aged 65-74 years significantly reduced all-cause mortality, though Dr. Diederichsen noted that the effects of screening might be underestimated as only 63% of those invited attended the screening.¹ Still, the subgroup analysis showed a possible benefit from screening among the younger age group of 65-69 years, and that CV screening among this group could improve outcomes and reduce mortality cost-effectively.